Redefining the upper age limit of decompressive craniectomy surgery for malignant middle cerebral artery infarct

Shaju Mathew, P. K. Balakrishnan, Parth V. Prakash, Ajax John, Haris Thottathil Pareed, Tom Jose


Background: Decompressive craniectomy is an effective treatment for malignant middle cerebral artery (MCA) territory infarct. But the age limit for surgery is not well defined. The time window of the surgery is considered less than 96 hours.

Methods: This retrospective study of 60 patients of MCA territory infarct who underwent decompressive craniectomy surgery is selected in this study and using modified Rankin score.

Results: In this study 36 patients were less than 60 years and were above 60 years. 38 patients were right sided and 22 were left sided MCA infarct. Out of 60 patients, 22 patients were operated within 48 hours of onset of symptoms and 38 were operated between 48 to 96 hours.  49% patients operated within 48 hours had modified Rankin score (mRS) 0–3 at 3 months follow up while only 37% patients operated after 48 hours had mRS 0–3 at 3 months follow up.

Conclusions: Decompressive craniectomy in malignant MCA infarction can reduce the case fatality rate but the favorable outcome is questionable. Hence the surgical decision should depend on social and patient factors.


Decompressive craniectomy, Modified Rankin score, Malignant MCA infarction

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